Provider Demographics
NPI:1194306704
Name:GARICA-DESJARLAIT, MARIA (EI)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GARICA-DESJARLAIT
Suffix:
Gender:F
Credentials:EI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-8165
Mailing Address - Country:US
Mailing Address - Phone:773-715-6567
Mailing Address - Fax:
Practice Address - Street 1:1308 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-8165
Practice Address - Country:US
Practice Address - Phone:773-715-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL362167743252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency